How tracking behavior, understanding triggers, and working with your child’s team can help take some of the guesswork out of mental health treatment.
Have you ever sat in a doctor’s office, talking about yet another medication for your child, and thought, "Are we just pulling names out of a hat at this point?"
Maybe you’ve tried three medications. Maybe you’ve tried ten. One helped a little but caused terrible side effects. Another seemed promising for a few weeks before things got worse. And now you’re sitting there wondering what comes next.
As a parent and Family Partner, I understand how frustrating this process can feel. You want your child to be happy, healthy, and safe. You want your family to feel safe, too. You’re not asking for a miracle. You’re asking for something that works!
And sometimes it really does feel like we’re flying blind.
The good news? There are ways to make this process more informed, even when there isn’t an easy answer.
Why Does Finding the Right Medication Feel So Hard?
The simple answer is that every person is different.
Two children can have the exact same diagnoses and respond very differently to the same medication.
Something that changes one child’s life for the better might cause another child to struggle with sleep, anxiety, mood changes, or other side effects.
This isn’t just something parents talk about. Research confirms that medication responses can vary, and providers may need to adjust medications or doses to find the right balance.
But here’s something I think we sometimes miss:
We can’t make the best treatment decisions if we don’t fully understand what we’re trying to treat.
For example, two children might both have severe emotional outbursts.
One may struggle with impulsivity related to ADHD. Another might become overwhelmed by fear or reminders of past trauma. A third might be dealing with both, along with poor sleep.
The behavior might look similar, but what’s happening underneath can be very different.
That’s why understanding the behavior matters just as much as finding the right medication.
Before We Try to Change the Behavior, Let’s Understand It
One of my favorite tools for this is something called an ABC chart.
ABC stands for:
- A — Antecedent: What happened right before the behavior?
- B — Behavior: What exactly did the child do or say?
- C — Consequence: What happened right afterward? How did people respond, and what happened next?
And no, consequence doesn’t automatically mean punishment! It simply means what followed the behavior.
ABC charts are often discussed in autism services or school behavior plans. But they can also be useful when looking at emotional struggles, anxiety, trauma, and other mental health needs.
In fact, the American Academy of Child and Adolescent Psychiatry recommends looking at what happens before and after severe emotional outbursts as part of understanding a child’s needs.
The idea is simple: Stop guessing and start looking for patterns.
Let’s look at an example.
Imagine a child comes home from school. Their parent asks them to put their backpack away.
The child starts yelling, throws the backpack, and storms into their bedroom.
At first glance, it looks like the child became angry over a simple request.
But let’s track it.
Antecedent: The child just arrived home after a long school day. They skipped lunch, the bus was loud, and a classmate had upset them.
Behavior: The child yelled, threw their backpack, and went to their bedroom.
Consequence: The parent stopped talking and gave the child space. About 15 minutes later, the child was calmer.
Now imagine we track this for a couple of weeks.
We might notice that most of these outbursts happen right after school, especially on days when the child hasn’t eaten or has had a stressful afternoon.
Suddenly, we’re looking at more than a child who doesn’t want to put away a backpack.
We’re asking whether the child is already overwhelmed before they even walk through the door.
That gives us something useful to work with!
Maybe the child needs a snack, some quiet time, or a chance to connect before being asked to complete tasks.
These are possibilities, not conclusions. An ABC chart helps us spot patterns, but it doesn’t prove why something happened. We still need to listen to the child and work with their team.
Sometimes the Trigger Seems Silly to Us, but It’s Still Real to Them
Here’s something I really want parents to understand.
A child’s emotional response can be much bigger than we would expect for a situation, but that doesn’t mean there was no reason for it.
Maybe your child gets upset because someone used a certain tone of voice. Maybe it’s a change in plans, an unexpected sound, or even the way the wind blows!
I’m not saying we need to change the way the wind blows. LOL.
But imagine that the feeling of wind against their face is truly uncomfortable or overwhelming for them.
We can recognize that this is a trigger without expecting the whole world to change around it.
And we can work on it from more than one direction.
The environment: Maybe we can avoid standing by an open window during an already stressful moment or give them a comfortable place to take a break.
The therapy: Maybe we work with a therapist on ways to recognize discomfort, communicate needs, and build coping skills.
The medication: If appropriate, medication might help with an underlying condition that’s making emotions or stress harder to manage.
See how those three pieces can work together?
We’re not teaching children that the world will always change to meet their needs.
We’re helping them understand their needs while building the tools and supports to manage a world that won’t always be comfortable.
And there’s an important difference between understanding why something happened and saying that an unsafe behavior is okay.
We can have compassion for a child’s feelings while still teaching safe ways to express them.
Trauma Can Make This Even More Complicated
When a child has experienced trauma, certain sounds, smells, situations, or interactions may remind their brain and body of something frightening.
Sometimes the child doesn’t even realize that’s what’s happening.
What looks like anger might involve fear. What looks like refusal might be a stress response.
The National Child Traumatic Stress Network explains that trauma can affect children’s emotions, behavior, and ability to manage stress.
This is another reason why looking beyond the behavior matters.
An ABC chart can help us notice possible trauma reminders. However, it can’t diagnose trauma or tell us what someone is feeling.
That’s where conversations, trust, and the right kind of therapy become so important.
For children dealing with PTSD, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is one treatment supported by strong research.
Medication may help with some symptoms, but it doesn’t replace the need for appropriate trauma treatment.
Make a Medication History: Your Own Little Research Project
This is another tool I strongly recommend.
If your child has tried multiple medications, consider creating a simple spreadsheet.
Record the medication name, dose, dates it was used, what it was supposed to help with, what improved, what got worse, and why it was stopped.
You can also track sleep, appetite, mood, and any changes in emotional outbursts.
Don’t forget to include medications that helped, even if they weren’t perfect!
For medications currently being used, it may be helpful to track how often outbursts happen, how long they last, and how serious they are.
For example, instead of telling the prescriber, "I don’t think this medication is helping," you might be able to say:
"Before starting it, my child was having four serious outbursts a week that lasted around 30 minutes. Over the past three weeks, we’ve seen two per week, and they’re lasting about 10 minutes. However, their sleep has gotten much worse."
That’s information a prescriber can work with!
It’s not perfect science. Sleep, stress, changes at school, and other factors can affect what you’re seeing.
But it gives you a clearer picture than trying to remember everything during a 20-minute appointment.
And please involve your child in this process whenever possible. Ask what feels better, what feels worse, and what changes they notice in themselves.
The goal isn’t simply to have a quieter child. It’s to help that child feel better and live the life they want.
What About Genetic Testing?
You may have heard about genetic tests that promise to help identify which psychiatric medications might work best.
These tests are called pharmacogenetic tests.
Some can give doctors useful information about how a person’s body processes certain medications.
However, there are important limits.
Genetic testing generally cannot tell us which psychiatric medication will work best, whether it will help with aggression, or exactly which side effects a child will experience.
The American Academy of Child and Adolescent Psychiatry advises against using these tests to select psychiatric medications for children and teens because the evidence is still limited.
In certain situations, specific genetic information may still help a clinician think about medication processing or dosing.
So it’s a reasonable question to bring up with your prescriber, especially after several difficult medication experiences. Just don’t feel like you’re missing a guaranteed answer if you haven’t done genetic testing.
Medication, Therapy, and Environment: Three Pieces of the Same Puzzle
One of the biggest lessons I want families to take away is that these supports aren’t competing with each other.
Sometimes medication makes a huge difference.
Sometimes the right therapy is what helps a child learn new ways to handle feelings.
Sometimes changing a stressful environment makes the biggest difference.
And sometimes all three need to happen together.
This is supported by research, too. For example, guidelines for school-age children with ADHD recommend medication alongside appropriate behavior supports and school accommodations.
And research on children who have experienced trauma supports treatments that build coping skills, safety, and supportive relationships.
A child might need medication to help manage attention or strong emotions while learning coping skills in therapy. They might also need changes at school so they’re not spending the entire day overwhelmed.
None of these pieces has to work alone.
What If We’ve Tried Everything?
First, I want to recognize how hard it is to reach that point.
When you’ve made every appointment, tried every suggestion, worked with multiple providers, and still don’t have the answers you need, it’s exhausting.
But I would encourage families to consider a different question.
Instead of asking only, "What medication haven’t we tried yet?" we can also ask:
"What haven’t we learned about what my child is experiencing?"
Have we reviewed the medication history together? Are we tracking patterns? Have we considered whether sleep, physical discomfort, anxiety, trauma, or school stress may be playing a role?
Are we treating the underlying conditions or only trying to reduce the outbursts?
Is the therapy actually meeting our child’s needs? Does our child feel heard by their treatment team?
And if things aren’t improving, would a second opinion from a child and adolescent psychiatrist be helpful?
For families dealing with aggression that puts someone at risk, a safety plan with the treatment team is also essential. Don’t wait to finish a behavior chart before seeking help with immediate safety concerns.
Knowledge Is Power, Especially When You’re Advocating for Your Child
Parents are often told to trust the process.
And yes, working with professionals is important.
But I also believe parents deserve to understand the process and be active partners in it.
You know what your child looks like on a good day. You see the hard moments, the small improvements, and the things that may never come up during an office visit.
Your child also has knowledge about their own experience that nobody else can fully provide.
When we combine that lived experience with professional knowledge, careful tracking, and research, we can make more informed choices together.
We might not find a perfect medication.
We might not be able to prevent every emotional outburst.
And we certainly can’t change the way the wind blows!
But we can learn more about what’s happening, try new approaches, and make changes based on what we’re learning.
Our goal isn’t to change who our children are. It’s to give them the best chance to feel safe, understood, supported, and able to enjoy their lives.
And sometimes that starts with something as simple as asking what happened before the behavior instead of only focusing on what happened afterward.
That’s not a magic pill.
But it’s a place to start. ❤️
Research and Resources
If you’re like me and love understanding the research behind the tools, these are some great places to start.
American Academy of Child and Adolescent Psychiatry (AACAP): Impairing Emotional Outbursts: Parents’ Medication Guide. Explains emotional outbursts, assessment, treatment options, and the importance of tracking symptoms.
Vanderbilt University IRIS Center: The ABC Model and Descriptive Assessments. Explains how tracking antecedents, behaviors, and consequences can help identify patterns.
https://iris.peabody.vanderbilt.edu/module/bp/cresource/q1/p02/
https://iris.peabody.vanderbilt.edu/module/fba-elem/cresource/q2/p06/
National Child Traumatic Stress Network: Trauma-Focused Cognitive Behavioral Therapy. Reviews an evidence-based approach to supporting children and adolescents experiencing PTSD and related difficulties.
https://nctsn.org/interventions/trauma-focused-cognitive-behavioral-therapy
Centers for Disease Control and Prevention: Treatment of ADHD. Explains how medication, behavior therapy, and school supports can work together.
https://www.cdc.gov/adhd/treatment/
AACAP: Pharmacogenetic Testing. Explains what genetic testing can and cannot tell families about medication.
AACAP: Psychiatric Medication for Children and Adolescents: Questions to Ask. A useful guide for making informed medication decisions with your child’s prescriber.
This article is for education and peer support. It is not medical advice. Medication decisions and changes should always be discussed with your child’s qualified prescriber.
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